Table 1.

A 10-Point Plan for Avoiding Filler Complications

I. Patient	II. Product	III. Procedure	IV. Algorithms
1. History Skin Systemic disease Medication Procedures Selection Skin, systemic disease Pretreat eg, acne, dermatitis Dental, vaccinations Routine procedures Cancer Rx Previous LOAE Body dysmorphic disorder	4. Reversibility Hyaluronidase Dilution, dosage~ types “Off-label”?	7. Photographs Pre and post SLR camera; consistent background No makeup or jewelry Rest and animation Angles and lighting Lateral: Frankfort plane Oblique: all 4 canthi	Allergy/hypersensitivity Early: vitals, adrenalin, IV H1 H2 antagonists Oral corticosteroids Propanol, ibuprofen Edema/swelling ~ Time of onset
2. Assessment Beauty, aging Ethnic nuancing Gender: LGBTQ+ identifiers Wants vs needs Muscle dynamics and indirect effects	5. Product characteristics HA concentration Cross-linking	8. Procedural planning and aseptic technique Technical flow Everything at hand ANTT Skin: chlorhexidine/alcohol/hypochlorous acid Mucosae: chlorhexidine/cyclodextrin + isoflavonoids/povidone iodine Gloves+ hand washing COVID-19 protection protocol bidirectional	Vascular events HDPH Avoid nitroglycerin paste If visual disturbance: a) Stop injecting b) Ophthalmological referral (speed dial) c) < 90-min timeframe
3. Consent Covid-19 guidelines Procedure Complication Rx: allergic, infective, vascular, LOAE Hyaluronidase, “off-label”? Financial consent Photographic consent	6. Product layering Caution: HA over minimally biodegradable fillers Unknown filler: Ultrasound	9. Injection anatomy Topographical anatomy 10 markings Danger areas Choke anastomoses Pinch anatomy	Infection Oral antibiotics Hyaluronidase Surgical drainage
		10. Technical knowledge Depth, placement Angles: 10, 30, 45, 90 degree Speed Volume Needle vs cannula Aspiration vs movement	Late-onset adverse events Antibiotics Hyaluronidase Immunosuppressives Allopurinol, colchicine

Abbreviations: Rx, treatment; LOAE, late onset adverse events; LGBTQ+, lesbian, gay, bisexual, transgender and queer or questioning; HA, hyaluronic acid; IV, intravenous; SLR, single-lens reflex; ANTT, aseptic non-touch technique; COVID-19, SARS-Covid virus disease of 2019; HDPH, high-dose pulse hyaluronidase.